New Guidelines Benefit Children With Psoriasis

When kids from school bullied him or teachers stared, 10-year-old Cyrus Harandi would do what his mom taught him to do: He’d sit under a tree at recess, close his eyes, and clear his mind.

Cyrus developed severe pediatric psoriasis when he was six. It manifested in the form of scalp psoriasis in the first grade, but it took more than a year to get a proper diagnosis. His mother, Teresa Cepeda, says the steroid creams would work for a short time and then his psoriasis would return, even angrier than before.

“It got to a point where he was crying at night, he couldn’t sleep, and he was struggling at school,” Teresa says.

The pain of his psoriasis, which at one point covered his entire body, would’ve been enough for a parent to handle. But Teresa said she was equally worried about her son’s mental health.

“The kids would say ‘don’t come near me,’ and the grownups didn’t want their children around him because they thought it was contagious,” she says. “So he was really emotional. He didn’t play sports; he didn’t have friends. He would come home and just break down in tears. He’d say ‘why, Mommy, why me?’"

So Teresa – an on-the-ball mother, by all measures — taught him some coping skills, including meditation. “It helps him to breathe, calm down, and let things go.”

Some good news came in July 2017, when the first-ever comorbidity screening guidelines for pediatric psoriasis were published in JAMA Dermatology. The authors, who work in dermatology, endocrinology, rheumatology, and cardiology received support from the National Psoriasis Foundation and the Pediatric Dermatology Research Alliance.

Like adults with the condition, pediatric psoriasis patients are more likely to develop mental health issues and obesity than their peers without it. They’re also more likely to develop arthritis, hypertension, and heart disease.

According to Larry Eichenfield, M.D., a pediatric dermatologist and a senior author of the guidelines, these screening guidelines have been around for adults for a long time. Pediatric practitioners did not have a psoriasis playbook until now.

“A lot of primary care physicians don’t always recognize pediatric psoriasis and there hadn’t been a concerted effort to educate patients or practitioners about its impact,” he says. “The clear desire of this group was to collect knowledge and heighten awareness about the disease and its impact.”

One-third of people with psoriasis develop the autoimmune disease during childhood. Dr. Eichenfield says practitioners should not wait until their psoriasis patients are adults to assess their mental, cardiac, or joint health.

“This makes total sense for us,” he says. “I believe it will drive more aggressive treatment of the disease, which will markedly improve health outcomes.”

While the guidelines are directed towards pediatricians, pediatric dermatologists and other medical professionals, Dr. Eichenfield said they can serve parents of children with psoriasis, as well.

“As a pediatric dermatologist, I know that most of my patients’ families don’t think of it other than as a skin disease, but it’s an inflammatory disease that doesn’t just have effects on the skin. It’s systemic. Children and teens [with psoriasis] have high rates of depression and anxiety, so the need to recommend mental health screenings was pretty obvious.”

For Teresa and Cyrus, things have improved in recent months. Cyrus is enrolled in a clinical trial that’s testing the effectiveness of a systemic medication for pediatric psoriasis. After his first shot last summer, Cyrus saw immediate clearance of his psoriasis. He’s stayed clear and he’s made friends; his self-esteem has skyrocketed.

Teresa said she hopes the medication continues to work and the FDA approves it for treatment. (Last year, the FDA green-lighted Enbrel as the first-ever biologic medication for psoriasis patients as young as four.)

But Teresa still meditates with Cyrus thirty minutes a day.

“This has taught him that we all have something in our lives that we need to learn how to deal with,” she says. “I recommend meditation for all kids with psoriasis — and for their parents. It helps you to be patient with them, because they really are suffering.”

Casey Nilsson writes about psoriasis and autoimmune diseases for HealthCentral. Casey is an award-winning magazine writer based in Providence, Rhode Island. She’s a 2017 Association of Health Care Journalists fellow and her story on unfair labor conditions for people with disabilities was a finalist for the 2016 City and Regional Magazine Association Awards. Follow her on Twitter @casey_nilsson.